Organization
PROVIDENCE HEALTH GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IJEOMA MGBOJI (OWNER)
(908) 906-7518
Entity
Organization
Contact information
Practice address
955 HALL STATION DR, BOWIE, MD 20721-6008
(908) 906-7518
Mailing address
955 HALL STATION DR, BOWIE, MD 20721-6008
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
04/29/2026
Last updated
04/29/2026
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